Optometry Billing Mistakes, Legal Cases and Audits

Over the past couple of years optometry billing mistakes and blatant fraud have become more and more common. Last year an Oklahoma optometrist was being sued by the state after his business wrongfully received over $1 million because of fraudulent billing. This year an optometrist from Kentucky has settled to pay the federal government $800,000 for improper billing practices. These two legal cases of inappropriate optometry billing dealt with the optometrists filing false insurance billing claims. In regards to the Oklahoma case, TulsaWorld.com reported the state said, the optometrist and his practice “knew, or should have known, that they were not keeping accurate, sufficient and complete patient records concerning the medical services they were purportedly providing to justify their billing, and that they were submitting inaccurate and false billing codes indicating that more services were provided and more time was spent in the care and treatment of Medicaid recipients than was actually provided…”

Why the rise in inappropriate optometry billing?

In an article last year from TheHealthLawFirm.com, it is explained that the optometry field has expanded its scope of practice in the last 10 years. As a result of this expansion, more extensive optometry billing practices have been introduced into the field.

How easy is it to make a billing mistake?

In the same article, an example of inappropriate billing is given. They explained there is a medical condition that affects the eyes called Meibomian Gland Dysfunction (MGD). However, there is no ICD-9 code for this condition. Many optometrists try to solve this issue by using replacement diagnosis codes such as 373.12 (Internal Hordeolum). However, many times Medicare or Medicaid deem these replacement codes as inappropriate. Whether mistake or fraud, insurance companies can deploy audits of your practice. These audits may result in the uncovering of other optometry billing and coding mistakes. The fines and penalties associated with inappropriate billing can cost your practice a lot!

Combating Billing Fraud/Mistakes

It is very difficult for optometrists and all physicians to stay on top of accurate and appropriate medical billing and coding. Applied Medical Systems is a professional medical billing and coding company. We provide specialized billing and coding services to help practices maintain accurate patient records and perform correct insurance claims processes. We can help save your practice time and money. For more information about our services, contact us today.